Two years ago, the U.S. Preventive Services Task Force recommended against routine prostate specific antigen (PSA) cancer screenings, citing evidence that the risks of screening outweigh the benefits. The new study, by researchers at Case Western Reserve University and University Hospitals Case Medical Center, found the USPSTF recommendation resulted in a decrease in the number of PSA screenings ordered by doctors — with the greatest decline seen among urologists.
 

 

The findings, published in The Journal of Urology, are likely to reinvigorate the debate over PSA testing, since many men's health specialists believe the PSA can be a valuable tool in identifying men at risk for prostate cancer — particularly when it is tracked over many years.
 

In fact, a new study by researchers from Memorial Sloan Kettering Cancer Center published this month found that areas where PSA screening is performed more frequently have lower death rates from prostate cancer than those where there is little testing.  
 

That research, published online in the Journal of the National Cancer Institute, contradicts the findings of past studies that have raised questions about the benefits of PSA screening and undercut the recent federal guidelines that recommend against routine testing for most men.
 

The findings — by Sloan Kettering scientists, working with cancer specialists from the Umeå University, Sweden — are based on an analysis of national Swedish cancer registries. They show that prostate cancer incidence and mortality rates are markedly lower in areas with frequent use of PSA testing compared with regions where little screening is done.
 

"Our results show that prostate cancer mortality was 20 percent lower in counties with the highest incidence of prostate cancer, indicating an early and rapid uptake of PSA testing, compared with counties with a slow and late increase in PSA testing," said lead researcher Pär Stattin.
 

PSA (prostate-specific antigen) is a protein produced in the prostate gland measured in a blood test. Higher levels may signal prostate cancer, but other conditions can raise PSA, including a urinary tract infection, and inflammation or enlargement of the prostate.  
 

PSA screening has been debated for years by prostate cancer specialists because it often catches low-risk cancers that patients are over-treated for with invasive biopsies and surgical removal of the prostate, a procedure that can leave men impotent and incontinent.
 

The American Urological Association recently recommended against PSA screening for average-risk men younger than 55 and older than 70 — echoing the USPSTF guidelines that men not get routinely screened using the PSA test.

 

But many men's health specialists and prostate cancer experts have argued the recommendations are ill-advised and that prostate tests — particularly went performed over time, which allows doctors to track trends and changes — are very effective in flagging men at risk.
 

For the new Case Western study, investigators examined data for PSA tests performed at University Hospitals Case Medical Center and its affiliated facilities between 2008 and 2013. During that period, 43,498 PSA screenings were performed, with the majority of the tests ordered by internal medicine (64.9 percent) practitioners, followed by family physicians (23.7 percent), urologists (6.1 percent), and hematologists/oncologists (1.3 percent).

 

The results showed that screening numbers started to decline in 2009 with the release of the initial PSA screening trial results, and then continued to decline after the USPSTF recommendations were issued.
 

"The recently published prostate screening trials and the USPSTF recommendations appear to have negatively impacted PSA screening," said lead investigator Robert Abouassaly, M.D., assistant professor of urology at Case Western Reserve University School of Medicine and University Hospitals Case Medical Center.
 

"These effects were more immediate and pronounced in the urban/academic setting, and more gradual in suburban and rural settings. Decreased prostate cancer screening was observed across all specialties over time, with, interestingly, the greatest impact seen among urologists."
 

As the controversy over PSA testing continues, health experts recommend that men consult their doctors or cancer specialists about the risks and benefits of screening to help them decide whether to have it performed.

Prostate cancer is the second leading cause of cancer death in men, causing nearly 30,000 deaths in the U.S. each year, according to the American Cancer Society. About one in seven men will be diagnosed with prostate cancer over the course of a lifetime; one in 36 will die from the disease.